A nurse is caring for an adult client who reports having trouble getting to sleep at night. Which of the following recommendations should the nurse make?

Choice A reason: Responding to family requires clinical judgment and communication skills beyond AP scope. Nurses handle this in mass casualty for accuracy.

Choice B reason: Triage prioritization needs nursing assessment skills, not AP training. Determining care order is a licensed responsibility in emergencies like this.

Choice C reason: Cleaning and dressing wounds involves sterile technique and assessment, outside AP scope. Nurses perform this in mass casualty settings.

Choice D reason: Taking vital signs is within AP scope, providing data for nurse triage. It’s a routine task, safely assigned in a mass casualty event.

Choice A reason: Difficulty swallowing isn’t a typical pain sign from epidural failure; it suggests throat or nerve issues unrelated to disc pain. Scientifically, this lacks connection to spinal analgesia efficacy, as herniated disc pain manifests elsewhere, not in pharyngeal function.

Choice B reason: Constipation may result from opioids in epidurals, not unrelieved pain. It’s a side effect, not a pain indicator. Scientifically, bowel changes reflect medication impact, not disc pain intensity, making this an unreliable marker for epidural effectiveness.

Choice C reason: Urinary retention is an epidural side effect from nerve blockade, not a direct pain signal. Scientifically, it indicates spinal anesthesia depth, not failure to relieve herniated disc pain, distinguishing it from pain-specific behavioral cues.

Choice D reason: Clenched teeth reflect facial tension, a common involuntary response to unrelieved spinal pain. Scientifically, this aligns with pain behavior studies, as muscle guarding and grimacing indicate persistent disc-related discomfort, signaling epidural inadequacy effectively.